Tolmetin is a nonsteroidal anti-inflammatory drug (NSAID) that is effective in treating fever, pain, and inflammation in the body. It is similar to ibuprofen (Motrin or Advil), naproxen (Naprosyn), and others. As a group, NSAIDs are non-narcotic relievers of mild to moderate pain of many causes, including injury, menstrual cramps, arthritis, and other musculoskeletal conditions. They work by reducing the levels of prostaglandins, chemicals that are responsible for pain, fever, and inflammation. Tolmetin blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower concentrations of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The FDA approved Tolectin in March 1976.

GENERIC AVAILABLE: Yes

Yes

Most patients benefit from tolmetin and other NSAIDs with few side effects. However, serious side effects can occur, and generally tend to be dose related. Therefore, it is advisable to use the lowest effective dose to minimize side effects. The most common side effects of tolmetin involve the gastrointestinal system, and these include:

• ulcerations,
• abdominal pain,
• cramping,
• nausea,
• gastritis,
• serious gastrointestinal bleeding,
• liver toxicity,
• stomach ulceration
• black tarry stools, and
• weakness.

Tolmetin should be avoided by patients with a history of asthma, hives, or other allergic reactions to aspirin or other NSAIDs. Rare but severe allergic reactions have been reported in such individuals. It also should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.

Other important side effects include:

• heart attacks
• strokes
• accumulation of fluid, and
• increased chance ofheart failure.

Tolmetin may cause or worsen high blood pressure and kidney failure.

The recommended dose is 200-600 mg three times daily. The maximum daily dose is 1800 mg. Tolmetin should be taken with food and 8-12 ounces of water to avoid stomach upset.

Tolmetin is generally used with caution in patients taking blood thinning medications (anticoagulants), such as warfarin (Coumadin), because of an increased risk of bleeding. Patients taking lithium (Eskalith, Lithobid) or methotrexate (Rheumatrex, Trexall) can develop toxic blood levels of either drug because tolmetin may inhibit their elimination from the body by the kidney. Side effects from cyclosporine also may be increased by tolmetin. Tolmetin may reduce the effectiveness of antihypertensives because it causes or worsens high blood pressure. NSAIDs may diminish the antihypertensive effect of ACE inhibitors.

Combining NSAIDs with angiotensin receptor blockers (for example, valsartan [Diovan], losartan [Cozaar], irbesartan [Avapro]) or angiotensin converting enzyme inhibitors (for example, enalapril [Vasotec], captopril [Capoten]) in patients who are elderly, volume-depleted (including those on diuretic therapy), or with poor kidney function may result in reduced kidney function, including kidney failure. These effects usually are reversible.

Persons who have more than three alcoholic beverages per day are at increased risk of developing stomach ulcers when taking tolmetin or other NSAIDs.

Tolmetin is generally avoided during pregnancy.

Tolmetin is excreted in breast milk. To avoid adverse effects in the infant, nursing mothers should decide whether to stop nursing or stop tolmetin.

What preparations of tolmetin are available?

Tablets or capsules: 200, 400, and 600 mg

How should I keep tolmetin stored?

Tolmetin should be stored at room temperature in a sealed container and protected from moisture.